Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
Jpn J Clin Oncol. 2010 Apr;40(4):349-52. doi: 10.1093/jjco/hyp172. Epub 2009 Dec 22.
The aim of this study was to determine the incidence and risk factors of postoperative inguinal hernia and to investigate whether the difference of approach could induce postoperative inguinal hernia after laparoscopic radical prostatectomy.
We reviewed 493 consecutive patients who underwent laparoscopic radical prostatectomy from November 2000 to November 2007, and evaluated various preoperative parameters, specifically age, prostate-specific antigen (ng/ml), body mass index (kg/m(2)), prostate volume (ml), previous major abdominal surgery, previous appendectomy, previous inguinal hernia repair and laparoscopic approach as risk factors for postoperative inguinal hernia.
Inguinal hernia occurred in 4 (4.9%) of the 81 patients in the transperitoneal approach group, and in 37 (9.0%) of the 412 patients in the extraperitoneal approach group. The overall incidence of inguinal hernia was 8.3% (41 of 493 patients). The median inguinal hernia-free survival time was 35 months and 6 months in the transperitoneal approach and extraperitoneal approach groups, respectively. Inguinal hernia developed within 2 years after surgery in 2 (50%) of 4 patients in the transperitoneal approach group, in 34 (91.9%) of 37 patients in the extraperitoneal approach group, for a total of 36 (87.8%) of 41 patients overall. Multivariate analysis showed that the extraperitoneal approach was a significant risk factor (P = 0.043) for inguinal hernia.
Inguinal hernia is a frequent complication after laparoscopic radical prostatectomy, and the incidence of inguinal hernia is greater with the extraperitoneal approach than with the transperitoneal approach.
本研究旨在确定腹腔镜根治性前列腺切除术后腹股沟疝的发生率和危险因素，并探讨不同入路是否会导致术后腹股沟疝。
我们回顾性分析了 2000 年 11 月至 2007 年 11 月期间接受腹腔镜根治性前列腺切除术的 493 例连续患者，并评估了各种术前参数，包括年龄、前列腺特异性抗原（ng/ml）、体重指数（kg/m2）、前列腺体积（ml）、既往腹部大手术、阑尾切除术、腹股沟疝修补术和腹腔镜入路，以评估其作为术后腹股沟疝的危险因素。
在经腹腔途径组的 81 例患者中，有 4 例（4.9%）发生腹股沟疝，在经腹膜外途径组的 412 例患者中有 37 例（9.0%）发生腹股沟疝。总的腹股沟疝发生率为 8.3%（493 例患者中有 41 例）。经腹腔途径组和经腹膜外途径组的中位腹股沟疝无复发生存时间分别为 35 个月和 6 个月。经腹腔途径组的 4 例患者中有 2 例（50%）在术后 2 年内发生腹股沟疝，经腹膜外途径组的 37 例患者中有 34 例（91.9%）发生腹股沟疝，总共有 41 例患者（87.8%）发生腹股沟疝。多因素分析显示，腹膜外途径是腹股沟疝的显著危险因素（P = 0.043）。
腹股沟疝是腹腔镜根治性前列腺切除术后常见的并发症，腹膜外途径的发生率高于经腹腔途径。
